=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003752692
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CP SNF OPS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2026
-----------------------------------------------------
Last Update Date | 04/27/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 W FRONTAGE RD
-----------------------------------------------------
City | OKEMAH
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74859-6442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-623-1936
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1305 SE ADAMS ST
-----------------------------------------------------
City | IDABEL
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74745-5240
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-286-1065
-----------------------------------------------------
Fax | 580-286-3926
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REGIONAL DIRECTOR
-----------------------------------------------------
Name | KATHY SUZETTE BAUCOM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 479-312-8280
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------